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The Opioid Epidemic: Impact on Inflammation and Cardiovascular Disease Risk in HIV

  • Complications of HIV and Antiretroviral Therapy (GA McComsey, Section Editor)
  • Published:
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Abstract

Purpose of Review

People infected with HIV through injection drug use are more likely to experience progression to AIDS, death due to AIDS, and all-cause mortality even when controlling for access to care and antiretroviral therapy. While high-risk behavior and concurrent infections most certainly are contributors, chronic immune activation, downstream metabolic comorbidities may play an important role.

Recent Findings

Altered intestinal integrity plays a major role in HIV-related immune activation and microbial translocation markers are heightened in active heroin users. Additionally, greater injection frequency drives systemic inflammation and is associated with HIV viral rebound. Finally, important systemic inflammation markers have been linked with frailty and mortality in people who inject drugs with and without concurrent HIV infection.

Summary

Heroin use may work synergistically with HIV infection to cause greater immune activation than either factor alone. Further research is needed to understand the impact on downstream metabolic comorbidities including cardiovascular disease. Medication-assisted treatment for opioid use disorder with methadone or buprenorphine may ameliorate some of this risk; however, there is presently limited research in humans, including in non-HIV populations, describing changes in immune activation on these treatments which is of paramount importance for those with HIV infection.

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Funding

The authors report funding from NIH NIDA R01DA044576 to COH and GAM.

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Authors and Affiliations

  1. MetroHealth Medical Center and Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Corrilynn O. Hileman

  2. University Hospitals Cleveland Medical Center, Rainbow Babies and Children’s Hospital and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Grace A. McComsey

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  1. Corrilynn O. Hileman
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  2. Grace A. McComsey
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Correspondence to Corrilynn O. Hileman.

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Conflict of Interest

COH has served on medical advisory boards for Gilead Sciences and as site PI for Gilead Sciences sponsored clinical trials.

GAM has served as a scientific consultant for Gilead, Merck, and ViiV and had received research grants from Roche, Tetraphase, and Astellas.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Complications of HIV and Antiretroviral Therapy

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Hileman, C.O., McComsey, G.A. The Opioid Epidemic: Impact on Inflammation and Cardiovascular Disease Risk in HIV. Curr HIV/AIDS Rep 16, 381–388 (2019). https://doi.org/10.1007/s11904-019-00463-4

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